Women’s Health in the Post-menopausal Age

Abstract

In recent human history, the trajectory of the human life cycle in industrialized cultures has undergone a profound shift. Dramatic increases (30–40 years or more) in average and maximum life expectancies have occurred, along with decreases in infant and maternal mortality rates, delays in childbearing, and fertility rate declines, plus lower mortality rates for older adults. Both the proportion and absolute numbers of older adults are growing globally, attributable in large part to the vast numbers of people born during the post-World War II “baby boom.” The extension of the human life span to “extreme” old ages (80–100 years or more) has been caused by changes in culture that have outpaced biological evolution, including better nutrition, sanitation, and medical care, as well as protection against deaths from accident and exposure. An equally dramatic epidemiologic transition has accompanied this demographic change, shifting major causes of death away from infection, injury, and exposure to later-onset diseases often characterized by an extended period of disability. Women are longer-lived on average than men, and the modern “longevity bonus” means that millions of us will live a third or more of our lives in a healthy post-menopausal state. On the other hand, more older women spend their later years struggling with chronic, disabling conditions, some of which are associated with declines in estrogen and progesterone after menopause. An evolutionary analysis of these trends provides a valuable perspective on how the health consequences of an extended post-reproductive life span for modern women.